Earlier treatment for diabetes‏

You don’t just wake up one morning and have diabetes. It is a progression of events that occurs of years, if not decades. Ninety percent of our diabetics today start by developing insulin resistance, which eventually leads to prediabetes and then to full-blown diabetes. As you have been learning, as soon as you “tip over” into this abnormal metabolic state called the metabolic syndrome, your arteries begin aging much faster than normal. By waiting until the patient becomes diabetic, it is simply too late. In August of 2008, the consensus conference I discussed in the last Health Nugget strongly recommended that we begin treating patients with prediabetes with intensive lifestyle management. This is a major step in the right direction. However, physicians must begin to recognize the early signs of insulin resistance and begin to intervene with aggressive lifestyle management even before they become prediabetic.

The Centers for Disease Control (CDC) has projected that over one-third of the children born after the year 2000 will develop diabetes sometime during their lifetime. If they happen to be Black, Hispanic, or Native American, the CDC projects that nearly 50% of the children will become diabetic. When you consider that diabetes is the leading cause of amputation, kidney failure, blindness, and neuropathy, the strain this projection will place on our health care system and society in general is tremendous. The answer is encouraging individuals to become proactive in protecting their health by firmly establishing these new, healthier lifestyles that improve insulin sensitivity.

Source: Dr. Strand Health Nuggets (newsletter@Bionutrition.org)

Treat prediabetes‏

Over 50 million people in the United States alone have prediabetes. In August of 2008 a consensus conference involving the American College of Endocrinology convened in Maryland. Dr. Handelsman, chair of the consensus conference said, “We felt we had to come out with some type of recommendation for how to treat these patients who had prediabetes.” Dr. Daniel Einhorn, medical director of the Scripps Whittier Institute for Diabetes in La Jolla, California stated, “Nothing else matches intensive lifestyle management in reducing the complications of prediabetes.”

Here are the first major recommendations for the treatment of patients who fall into this category of having prediabetes. Previously, physicians have been advised to just follow these patients and when they develop diabetes to begin their treatment. What is interesting is the fact that when this conference looked at all the evidence that was available from our previous clinical trials, aggressive lifestyle management was the absolute best way to treat these patients. Drug use was just not near as effective in reducing the complications of prediabetes as were lifestyle changes.

Source: Dr. Strand Health Nuggets (newsletter@Bionutrition.org)

Cardiovascular disease and diabetes‏

Eighty percent of diabetic patients today will die prematurely from a cardiovascular event like a heart attack, stroke, or ruptured aneurysm. This was true in 1970 and is true today. In spite of all our medication and present treatments for diabetes, we have not been able to change this horrible statistic. Now it is true that we are able to decrease the risk of what is referred to as microvascular disease like diabetic retinopathy and neuropathy. However, we have not been able to decrease the risk of major cardiovascular disease. Why is this happening?

As you have been learning in prior Health Nuggets, our arteries begin aging much faster than they should as soon as you develop insulin resistance. It may be 10 to 15 years before you actually develop diabetes. Clinical trials have shown that the day we actually diagnose a patient in our office as being diabetic that 60% of them already have major cardiovascular disease. Now that they are diabetic, their arteries will actually begin to age even faster. Physicians are behind the eight ball and are really intervening with their traditional treatments too late. The answer to this dilemma is to begin treatment earlier before the patient actually becomes diabetic.

Source: Dr. Strand Health Nuggets (newsletter@Bionutrition.org)

Insulin resistance leads to diabetes‏

The overwhelming majority of patients who have insulin resistance will eventually develop diabetes. When a patient becomes insulin resistant, the body compensates for this situation by making more and more insulin. As blood insulin levels rise, the patient literally “tips over” into this abnormal metabolic state called the metabolic syndrome. As long as the patient continues to make enough insulin to compensate for the fact that they just aren’t as sensitive to their insulin as they once were, the blood sugar remains normal. However, over time the body just can’t keep making that much insulin and insulin levels will eventually begin to drop. When this happens, blood sugars will begin to rise. Initially they will have elevated fasting blood sugars that indicate prediabetes (blood sugar levels from 100 mg/dl [5.5 mmol/L] to 125 mg/dl [6.9 mmol/L]. Then over time most of these individuals will develop full-blown diabetes mellitus (fasting blood sugar greater than 125 mg/dl [6.9 mmol/L].

This is the pattern seen in over 90% of the diabetic patients today. Patients will show signs of insulin resistance 10 to 15 years before they actually become diabetic. The problem is the fact that as soon as a patient develops insulin resistance their arteries begin to age much faster than they should. This is understandable when you begin to realize all of the metabolic changes that accompany this abnormal metabolic state. Most physicians do not treat early insulin resistance because there is no drug approved by the FDA in this situation. Physicians are trained to wait until the patient develops one or more of the consequences of insulin resistance like high blood pressure, elevated cholesterol, diabetes, or heart disease before they begin to treat the patient with drugs.

Source: Dr. Strand Health Nuggets (newsletter@Bionutrition.org)

Fish oil lowers heart rate‏

There is significant evidence that omega-3 fatty acids have a beneficial effect on heart arrhythmias (irregular heart beat), which can lead to a decreased risk of death from cardiovascular disease. New analyses indicate that regular fish oil intake could correspond to as much as a 5% reduction in population-wide sudden deaths.

A meta-analysis published in the journal Circulation further confirms the association between omega-3 fatty acids and heart health. Researchers from the Harvard School of Public Health compiled statistical data from thirty studies published from 1996 to 2005. These studies involved nearly 1,700 individuals treated with fish oil or placebo for up to one year. The average combined dose of EPA and DHA was 3.5 grams/day for an average of 8 weeks.

The overall estimated change in heart rate of those treated with fish oil was 1.6 beats per minute. The reduction in heart rate was even greater in trials where the participants had higher baseline heart rates. In those studies, treatment with fish oil resulted in a decreased heart rate of 2.5 beats per minutes. There was no evidence of a dose-response effect, and heart rate was not significantly different between higher and lower doses compared with placebo.

Although the overall effect of fish oil on heart rate appears small, researchers estimate that on a population-wide basis this could correspond to as much as a 5% reduction in sudden death.

Source: Effect of fish oil on heart rate in humans. A meta-analysis of randomized controlled trials. Mozaffarian D, Geelen A, Brouwer IA, Geleijnse JM, Zock PL, Katan MB. Circulation 2005;112:1945-1952.

Killer fat‏

Central weight gain is a hallmark sign of insulin resistance. Even though not everyone who develops insulin resistance will also have central weight gain, approximately 85 to 90% will gain a significant amount of weight around their middle. This is why physicians are beginning to take out their tape measure during an annual physical exam, instead of just weighing their patients. Central weight gain is associated with elevated blood pressure, elevated triglyceride levels, low HDL or good cholesterol, high total and LDL or bad cholesterol, along with an increase risk of developing clots (increased fibrinogen levels).

Another hallmark sign of central weight gain is a tremendous increase in the amount of inflammation you have in your arteries. Central fat releases a tremendous amount of inflammatory products. Your highly sensitive C - reactive protein (hsCRP), which measures inflammation in your arteries and is a very good indicator of having a higher risk of a heart attack, can rise significantly. You can see why I am so concerned when a patient who comes into my office for their annual physical and is showing signs of an expanding waist size. All you have to do is take out a tape measure and measure 1 inch below your belly button and over the top of your hips. This is the best measurement for central abdominal fat. Women should become concerned when this gets above 32 to 33 inches and men should become concerned when it gets above 36 to 37 inches.

Source: Dr. Strand Health Nuggets (newsletter@Bionutrition.org)

Central obesity - killer fat‏

One of the hallmark signs of the metabolic syndrome is central weight gain. I become very concerned when I note that a patient’s waist size has expanded. I become concerned when a woman has a waist size greater than 32 to 33 inches or a man has a waist greater than 36 inches. I measure the waist an inch below the belly button and across the top of the hips. The reason I become concerned is because this is an early sign that my patients are beginning to develop insulin resistance. This central weight gain is associated with all the other problems regarding the metabolic syndrome. When a woman’s waist size is over 34 ½ inches or a man’s waist size is over 40 inches, the metabolic syndrome may already exist.

Once patients have developed the metabolic syndrome, their arteries begin aging a third faster than they should. This is why physicians are now beginning to refer to this unusual weight gain around their middle as “Killer Fat.” This weight gain is associated with all these risk factors for developing cardiovascular disease. Another important recent finding is that this central obesity, by itself, creates a tremendous amount of increased inflammation in our arteries.

Source: Dr. Strand Health Nuggets (newsletter@Bionutrition.org)

Hyperinsulinemia is an independent risk factor for heart disease‏

Several clinical studies show, and all researchers agree, that elevated insulin levels (Hyperinsulinemia) present independent risk factors for heart disease. When you consider all of the abnormal health risks that are the direct result of increasing levels of insulin in your body, it is easy to realize why this is true. As insulin resistance increases, the body compensates for this situation by simply making more and more insulin. These elevated insulin levels cause our arteries to age much faster than they should. One of the main reasons is that high insulin levels within our blood stream can actually cause inflammation. When you consider the constellation of problems related to the metabolic syndrome, you can see why high insulin levels are not desirable.

Because of our poor eating habits and lack of exercise in the US, Canada, and throughout the world, more people are developing insulin resistance. Clinical studies now show that nearly 25% of the adult population in the US and Canada now has metabolic syndrome. Another 25% of the population is on the way to developing the metabolic syndrome. My book Healthy for Life [Real Life Press 2006] details this problem and presents the solution to people who would like to avoid this problem or possibly reverse it if they already have it.

All my books are available at http://www.drraystrand.com/.

Also consider checking out my Online 12-Week Healthy for Life Program at http://www.releasingfat.com/.

Source: Dr. Strand Health Nuggets (newsletter@Bionutrition.org)

Higher vitamin E intake associated with lower lung cancer risk‏

New research indicates that higher intakes of vitamin E in the forms of alpha, beta and gamma-tocopherol may be associated with a reduced risk of lung cancer. In this study population, Vitamin E as alpha-tocopherol reduced the risk of lung cancer by as much as 61 percent.

Higher vitamin E intake associated with lower lung cancer risk

A study published in the September 1, 2008, issue of the International Journal of Cancer evaluated the effect of alpha, beta, gamma and delta tocopherols on lung cancer risk. Until recently, studies of vitamin E and cancer have focused on the alpha-tocopherol form of the vitamin. However, the lesser known fractions (in particular gamma-tocopherol) have increasingly been the subject of scientific research.

In an on-going study of 1,088 incident lung cancer cases and 1,414 healthy controls, researchers studied the associations between four tocopherols (alpha-, beta-, gamma-, and delta-tocopherol) in the diet and lung cancer risk. Higher intakes of alpha, beta and gamma-tocopherols were found to be associated with a reduced risk of lung cancer. When groups with the highest and lowest alpha-tocopherol levels were compared, those with intakes in the highest 25 percent showed a 61 percent reduction in lung cancer risk. For both beta-tocopherol and gamma-tocopherol, subjects whose intake was highest experienced a 44 percent lower risk compared to the lowest intake groups. No significant association was observed between delta-tocopherol and lung cancer risk.

Since this is the first report of the independent associations of the four forms of dietary tocopherols (alpha-, beta-, gamma- and delta-tocopherol) on lung cancer risk, the researchers suggest further research concerning the various forms of vitamin E and cancer risk.

Source: Dietary alpha-, beta-, gamma- and delta-tocopherols in lung cancer risk, Mahabir et al, Int J Cancer 2008 Sep 1;123(5):1173-80

The metabolic syndrome‏

Dr. Gerald Reavens, a physician and researcher from Stanford University, identified a constellation of problems individuals develop when they become less and less sensitive to their own insulin. This is referred to as insulin resistance. When the body becomes less sensitive to its own insulin, it compensates for this situation by actually making more and more insulin. As blood insulin levels begin to rise (hyperinsulinemia), you literally “tip over” into an abnormal metabolic state, which is referred to as the metabolic syndrome. These individuals usually develop:

- Central Obesity
- High Blood Pressure
- Elevated triglyceride levels (the other fat in the blood)
- Elevated VLDL cholesterol (or the very “bad” cholesterol because it is even easier to oxidize and cause inflammation of your arteries)
- Low HDL or “good” cholesterol
- Increased clotting of your blood
- Polycystic ovarian disease in women
- Sleep Apnea
- Reflux
- Very high risk of developing heart disease and diabetes

You can see why Dr. Reavens has reported that individuals who have metabolic syndrome have a 20-fold increased risk of having a heart attack.

Source: Dr. Strand Health Nuggets (newsletter@Bionutrition.org)

Serious or Competitive Athlete Part 1—Energy Production

September 2008

This month's newsletter is focused on energy production within the cell and is primarily aimed at the serious or competitive athlete. However, this information is also critical for anyone who has an exercise program. So much has been written in the literature about the use of high-glycemic carbohydrates as the key for those competitive athletes. I am going to present cutting-edge information in regards to the best way to nourish your body to optimize performance and recovery. Even though there are not many clinical trials that have used low-glycemic meals in athletes, the evidence I present is very compelling. This information is critical for any serious athlete or athletic team.

Source

This newsletter has been written by Ray D. Strand, M. D. who is a family physician who has been involved in a private family practice for over 30 years. For the past 12 years, he has focused his practice on nutritional and preventive medicine. He has written several best selling books like What Your Doctor Doesn't Know about Nutritional Medicine, Death by Prescription, and Healthy for Life. He has lectured across the US, Canada, Australia, New Zealand, Malaysia, and Singapore on preventive and nutritional medicine. He has also appeared on many radio and television shows.

His primary focus is to guide and educate those individuals who desire to become more proactive in protecting their health or regaining their health. His "online" medical practice is located at www.drraystrand.com*** where he shares a wealth of information in regards to those healthy lifestyles that have been shown to truly protect your health or even allow you to regain your health if you have already lost it. Members of his "online" medical practice also have personal access to Dr. Strand via email and phone consults at a very reasonable fee. Members also have access to his specific nutritional recommendations for over 100 different diseases and his bi-monthly newsletter.

There is so much information that is now available on the Internet today and it is hard to know what is true and what is not. Dr. Strand's mission is to be that health care provider that you can trust.

On his website, he also shares his clinical experience along with his extensive research of the medical literature in the following forms:

* Specific Recommendations
* Healthy Lifestyles
* Newsletters
* Health Nuggets